1. DIAGNOSTICS SPHS 5780 (LECTURE 2)

2. THE NATURE OF DIAGNOSIS AND EVALUATION

3. We pose questions, then seek and propose answers to them, to better understand the nature of the client’s communication disorder Some think of this as a “problem-solving,” “puzzle- solving”, a “detective-like” process, or “conducting research”. Which metaphor do you prefer?

4. THE NATURE OF DIAGNOSIS AND EVALUATION Note that the first step is…. posing your questions! Which metaphor for the diagnostic process is Tomblin using here?

5. THE NATURE OF DIAGNOSIS AND EVALUATION We pose questions, then seek and propose answers to them, to better understand the nature of the client’s communication disorder…. Formulate some example questions.

6. UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER”

7. World Health Organization (WHO) The nature of the client’s communication disorder includes all of these, as well as dynamic changes over time. Let’s discuss some examples.

8. UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER” The “diagnostic model” of your work setting will make assumptions about how to understand “the nature of the client’s communication disorder” -- Medical model -- Behavioral model -- Systems/social model

9. MODELSettingGoal of the diagnostic process Where does the problem rest? How do we attempt to make changes? HospitalFind cause, categorize problem In clientAddress cause SchoolsCharacterize performance within setting In clientChange behavior At home, in classroom (natural context) Figure out which context promotes successful performance Mismatch b/w client and context Change context Medical Behavioral Systems/ Social

10. UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER” This “understanding” is the goal we constantly strive toward, but this goal is rarely attained. Why?

11. UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER” Factors that complicate and challenge our understanding Clients are dynamic and complex Time is limited Information is incomplete or unreliable Data conflict with each other Inferences are flawed We make mistakes Our experiences may “garden path” us We are biased as humans (e.g., culturally) Let’s discuss some examples that you’ve experienced.

12. UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER” How to overcome complications and challenges to our understanding Plan ahead, but be ready to change your plan Recognize and acknowledge when we don’t know….then follow through on finding an answer. Maintain a sense of curiosity Be flexible, and ready to adapt your inferences Summon your creativity and innovations to solve problems

13. UNDERSTANDING THE “NATURE OF THE CLIENT’S COMMUNICATION DISORDER” Discuss how you might address each of these challenges.  You are seeing your first diagnostic client with aphasia, and you haven’t had Lang III.  Your diagnostic session is limited to one hour, and you need more time.  Your client with suspected stuttering did not complete his written questionnaire.  You don’t understand what all the numbers on the CELF mean when you score it.  Your client is Hmong and illiterate.  The client asks you a question, and you don’t know the answer.  The client who was referred for an “articulation disorder” appears to be an autistic child with a hearing loss.  Your client’s diagnostic profile is so complex that you cannot come up with a diagnosis.  You make a Dx of spastic dysarthria and your co-clinician makes a Dx of flaccid dysarthria.  The client’s medical reports state that he has a left hemiplegia, and when he arrives, he has a right hemiplegia.  There is no standardized test available for testing the vocal quality of your voice client.  You want to assess a child’s functional communication at home, but you can assess the child only in the clinic.

14. THE EVALUATION PROCESS

15.  Pose _______________________  Gather information  Synthesize findings (through process of inference)  Disseminate conclusions and act on them  Counsel Look for these process components on your syllabus

16. THE EVALUATION PROCESS Look for these process components on your syllabus

17. THE EVALUATION PROCESS Where do our original “step” fall in the evaluation process?  Pose question  Gather information  Synthesize findings  Disseminate conclusions and act  Counsel

18. THE EVALUATION PROCESS Although these look like sequential “stages”, each part of the process is happening simultaneously, throughout the evaluation process.

19. INFORMATION GATHERING (ONE PART OF THE EVALUATION PROCESS)

20. INFORMATION GATHERING Note that the first step in the information- gathering process is….posing your questions! Which of these steps are you doing in your diagnostic practicum right now? Could we take steps 2-5 without step 1?

21. INFORMATION GATHERING The first step is…posing your questions! Change each of these possible diagnostic goals into a question for your current case. Make the question as specific as possible.  Determination of the complaint  Determining the existence of a communication disorder  Determining client and family reactions and attitudes to the disorder  Identifying associated problems  Determining the factors causing or exacerbating the problem  Determining the course of the problem (historical, over time, prognostic)  Determining eligibility for therapy  Determining therapy approach  Determining the client’s use of his/her communication skills  Determining how the client functions in his/her daily contexts

22. INFORMATION GATHERING Look for these process components on your syllabus

23. INFORMATION GATHERING Look for these process components on your syllabus

24. INFORMATION GATHERING: FORMAL VS. INFORMAL TESTING …AN INTRODUCTION

25. INFORMATION GATHERING: FORMAL VS. INFORMAL TESTING Formal: Norm-referenced testing Informal: Criterion-referenced testing

26. PURPOSE OF FORMAL VS. INFORMAL TESTING Formal: Determine eligibility for services Informal: Determine nature of services

27. PURPOSE OF FORMAL VS. INFORMAL TESTING

28. NATURE OF FORMAL VS. INFORMAL TESTING Formal: Establish groups of scores against which client is compared. Uses converted scores to characterize broad trait. ). Where does my client’s score fall in the range of scores for a large group of similar people? Above or below measure of central tendency? How far above or below the measure of central tendency? Measure of central tendency Normal variability of performance around that measure of central tendency (sometimes expressed as standard score) 100 85

29. NATURE OF FORMAL VS. INFORMAL TESTING Informal: Establish performance standard (criterion) against which the client is compared. Expressed as Y/N (+/-). Uses raw scores to characterize in high detail. Examples: Does child have any hypernasity? Does the child display a phonological process of fronting? Does the child understand vocabulary needed for success in a second-grade classroom? Does the child have MLU in the normal range for his age? Does the adult with aphasia phone a merchant for information? Is the child at least 80% accurate in his producion of /r/ in discourse contexts? Is hearing sensitivity at least 25 dB in the speech range for both ears? The standard could be based on: 1)Client’s previous performance) 2)Normal level of mastery 3)Clinician knowledge and experience

30. INFORMATION GATHERING: CASE HISTORY TAKING

31. Written case history Interview-based case history